Pendapatan Daerah, Pembiayaan Kesehatan, dan Gizi Buruk pada Balita: Studi Korelasi Tingkat Kabupaten/Kota

Pendanaan kesehatan merupakan salah satu faktor penting dalam memengaruhi derajat kesehatan, termasuk salah satu masalah gizi pada Balita yang disebut gizi buruk. Oleh karena itu, penelitian ini bertujuan mendeskripsikan pendapatan daerah dan pembiayaan kesehatan serta korelasinya dengan gizi buruk pada Balita di tingkat kabupaten/kota di Indonesia tahun 2007. Penelitian ini merupakan studi ekologi/korelasi. Data pendapatan daerah dan pembiayaan kesehatan didapat dari Kementerian Keuangan, sedangkan data gizi buruk menggunakan data Riset Kesehatan Nasional tahun 2007. Sebanyak 250 kabupaten/kota yang diteliti dengan tidak mengikutsertakan kabupaten/kota yang datanya tidak lengkap atau tidak valid. Secara nasional, hanya persentase pendapatan asli daerah (PAD) per total pendapatan yang berkorelasi dengan gizi buruk, meskipun korelasinya lemah (r = 0,22). Berdasarkan kawasan di Indonesia, Kawasan Indonesia Barat dan Kawasan Indonesia Timur menunjukkan persentase PAD per total pendapatan berkorelasi lemah dengan gizi buruk (r = 0,20 dan r = 0,53). Terlihat kecenderungan bahwa semakin tinggi persentase pendapatan daerah dan pembiayaan kesehatan, semakin rendah persentase gizi buruknya. Korelasi antara pendapatan daerah, pembiayaan kesehatan dan masalah status gizi tidak dapat diabaikan. Data yang lebih lengkap dan valid diperlukan untuk dikembangkan penelitian selanjutnya.Health financing is one of the factors which contribute important role in influencing health status, including nutritional problem among children under five, called severely wasted. Therefore, the aim of this study was to describe districts income and health financing and examine it correlations with the prevalence of severely wasted among children under 5 years at regencies/ municipalities level in Indonesia in 2007. This research was an ecological study. Data on revenue and health financing were obtained from Ministry of Finance, and severely wasted data were obtained from the Indonesian Basic Health Research (Riskesdas) 2007. There are 250 regencies/municipalities were being objects of this research, while the others were excluded due to incomplete/missing or invalid data. Result shows nationally, only the percentage of local revenue by total district income had correlation with severely wasted, although it is weak (r = 0,22). By regions, in the Western Region Indonesia and the Eastern Region Indonesia, those variable had weak correlation with severely wasted (r = 0,20 and r = 0,53). The graphics trend shows higher percentage of local revenue and health financing, related to lower number of the prevalence of severely wasted. The correlation between district income and health financing for poor nutritional status cannot be ruled out. More valid and complete data on district income and health financing is needed for further research

Hubungan Antara Menyusui Dengan Risiko Kanker Ovarium

Incidence of Ovarian Cancer, which has a high mortality rate, has been reported to increase since 2008 in Indonesia. A number of protective factors have been identified, one of which is breastfeeding. Despite this, published literature on the association of breastfeeding and ovarian cancer in Indonesia has not been found. The aim of this study is to determine the effect of breastfeeding on ovarian cancer in general, as well as among pre and post menopause patients. This case control study was done at “Dharmais”Cancer Hospital, involving 71 patients with ovarian cancer as the cases, and 140 cervical cancer patients who served as the controls. Interviews were done during follow-up visits. Patients, with adouble primary cancer,were not included in the study. The study shows that lifetime breastfeeding contributes to a decrease in the risk of ovarian cancer by 55% (OR=0.45, 95%CI 0.23 – 0.91) among all cases; the decrease was 53% (OR=0.47, 95%CI 0.23 – 0.96) for those who had previously given birth. These results were adjusted for level of education and menopause status at the time of diagnosis. Women with a history of breastfeeding have a lower risk of having ovarian cancer. The longer the duration of breastfeeding, the lower the risk of having ovarian cancer. The reduced risk was more than 50% for those with a lifetime breastfeeding of 24 months or more

Assessment of Road Network Connectivity in Support of New Capital Development

The shifting of the capital of Indonesia from Jakarta to East Kalimantan, or East Borneo, is underway. There are certain to be new issues that arise as a result of this migration. The state of the nation's current transportation infrastructure is one of the most prominent right now. The new capital of Indonesia, Jakarta, is situated in the midst of a jungle. For this reason, the road network should be established before, or at least concurrently with, the IKN construction. It is critical to understand the direction of future growth in the IKN region before developing a road network architecture. Potential partner locations might potentially benefit from enhanced access and connection to the existing road network in this situation as well. To ensure that the IKN is able to work properly and link additional nodes, many partner area points are being considered. A literature review, a focus group discussion, and in-depth interviews were conducted to come up with a development plan for IKN partner regions and highlight areas of special concern. It was also determined if the addition of a new node had a positive impact by utilizing a connection matrix and the accessibility index. Most linkages are found at five of the 26 nodes in the complete connectivity matrix of national highways around IKN in East Kalimantan. Node 3 and Node 7 are the most accessible and easy-to-access component nodes of the road network, compared to other nodes. Doi: 10.28991/CEJ-2022-08-10-011 Full Text: PD

Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.</p> <p>Methods</p> <p>Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.</p> <p>Results</p> <p>There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).</p> <p>Conclusion</p> <p>Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.</p

Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss

<p>Abstract</p> <p>Background</p> <p>To evaluate the performance of the WHO criteria for defining maternal near miss and identifying deaths among cases of severe maternal morbidity (SMM) admitted for intensive care.</p> <p>Method</p> <p>Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18 died. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score were retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die defined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each one of the six components of the score, being considered the gold standard for the diagnosis of maternal near miss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum SOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting maternal death and also for identifying cases of organ failure were estimated.</p> <p>Results</p> <p>The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent criteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (≥1 h). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of the 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near miss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with no failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve of 0.897) for prediction of cases of maternal near miss according to the WHO criteria.</p> <p>Conclusions</p> <p>The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost all cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently enable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers.</p

Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan.</p> <p>Results</p> <p>The mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan.</p> <p>Conclusion</p> <p>Individual women, families and communities need to be empowered to contribute positively to making pregnancy safer by making a birth plan.</p

Did professional attendance at home births improve early neonatal survival in Indonesia?

BACKGROUND Early neonatal mortality has been persistently high in developing countries. Indonesia, with its national policy of home-based, midwife-assisted birth, is an apt context for assessing the effect of home-based professional birth attendance on early neonatal survival. METHODS We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the 'Midwife in the Village' programme was initiated. RESULTS Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes. CONCLUSIONS Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies